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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />Diana K. Watson <br />M-1979-103 <br />Amick Pit <br />Apri18, 2003 <br />$281.00 (Due on or before your anniversary date) <br />liio Blanco <br />RECEIVED <br />MAR 161003 <br />Division of Minerals and Geology <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator _ _ <br />s a su inn the annual-fee, a report an map s owing t e extent of current disturbances to affected land,i <br />reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ynnr revised written annnal rennrt and annual report m =n to this form. Please note that an <br />adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Diana K. Watson <br />Permittee Name: Diana K. Watson <br />Address: P.O. Box 1056 <br />Meeker, CO 81641 <br />._ (970)_878-5898 ,__.. _ ____ __ <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />/.CtiY7,GZ /~~~~ <br />Signature of Corporate Officer, Owner, or Designee <br />3/.~y /~ ~ <br />Date <br />M:~PERM17w1ASTERD000MENTSU4-AF-01 <br />